title: Improved fibrosis staging by elastometry and blood test in chronic hepatitis C.
abstract: OBJECTIVE
  Our main objective was to improve non-invasive fibrosis staging accuracy by resolving the limits of previous methods via new test combinations. Our secondary objectives were to improve staging precision, by developing a detailed fibrosis classification, and reliability (personalized accuracy) determination.
  
  
  METHODS
  All patients (729) included in the derivation population had chronic hepatitis C, liver biopsy, 6 blood tests and Fibroscan. Validation populations included 1584 patients.
  
  
  RESULTS
  The most accurate combination was provided by using most markers of FibroMeter and Fibroscan results targeted for significant fibrosis, i.e. 'E-FibroMeter'. Its classification accuracy (91.7%) and precision (assessed by F difference with Metavir: 0.62 ± 0.57) were better than those of FibroMeter (84.1%, P < 0.001; 0.72 ± 0.57, P < 0.001), Fibroscan (88.2%, P = 0.011; 0.68 ± 0.57, P = 0.020), and a previous CSF-SF classification of FibroMeter + Fibroscan (86.7%, P < 0.001; 0.65 ± 0.57, P = 0.044). The accuracy for fibrosis absence (F0) was increased, e.g. from 16.0% with Fibroscan to 75.0% with E-FibroMeter (P < 0.001). Cirrhosis sensitivity was improved, e.g. E-FibroMeter: 92.7% vs. Fibroscan: 83.3%, P = 0.004. The combination improved reliability by deleting unreliable results (accuracy <50%) observed with a single test (1.2% of patients) and increasing optimal reliability (accuracy ≥85%) from 80.4% of patients with Fibroscan (accuracy: 90.9%) to 94.2% of patients with E-FibroMeter (accuracy: 92.9%), P < 0.001. The patient rate with 100% predictive values for cirrhosis by the best combination was twice (36.2%) that of the best single test (FibroMeter: 16.2%, P < 0.001).
  
  
  CONCLUSIONS
  The new test combination increased: accuracy, globally and especially in patients without fibrosis, staging precision, cirrhosis prediction, and even reliability, thus offering improved fibrosis staging.
authors.affiliation: Liver-Gastroenterology Department, CHU Angers, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, LUNAM University, Angers, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Calès
authors.forename: Jérôme
authors.initials: J
authors.lastname: Boursier
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ducancelle
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.forename: Isabelle
authors.initials: I
authors.lastname: Hubert
authors.forename: Gilles
authors.initials: G
authors.lastname: Hunault
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Zarski
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon
authors.forename: Françoise
authors.initials: F
authors.lastname: Lunel
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D054459:Elasticity Imaging Techniques; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers
keywords: blood test; cirrhosis; diagnosis; diagnostic accuracy; fibroscan; hepatitis C; liver biopsy; liver fibrosis; reliability